DONA REMEDIOS TRINIDAD ROMUALDEZ MEDICAL FOUNDATION

COLLEGE OF NURSING

PERFORMANCE EVALUATION CHECKLIST

Procedure: NGT Insertion ,Feeding

Name: _________________________________________ Year Level & Section: _____________

Date of Performance: _____________________________ Clinical Group: __________________

Procedure DON NOT DONE Remarks

E
Inserting a nasogastric tube
1.Check patency of nares and intactness of
nasal tissues.Check for history of nasal
surgery or deviated septum
2.Determine presence of gag reflex.
3.Assess mental status or ability to
cooperate with procedure.
4.Before inserting a nasogastric tube,
determine the size of tube to be inserted
and whether or not the tube is to be
attached to suction.
5.Assist the client to a high-Fowler’s
position if his or health condition permits
and support the head on a pillow.
6.Place a towel or disposable pad across
the chest.
7.Explain to the client what you plan to
do.The passage of a gastric tube is not
painful , but it is unpleasant because the
gag reflex is activated during
insertion.Establish a method for the client
to indicate distress and a desire for you to
pause the insertion.Raising a finger or hand
is often used for this.
8.Wash hands and observe other
appropriate infection control procedures
(e.g. clean gloves)
9.Provide for client privacy.
10.Assess the client’s nares.
a)Ask the client to hyperextend the head
and using a flashlight, observe the
intactness of the tissues of the nostrils,
including any irritations or abrasions.
b)Examine the nares for any obstructions or
deformities by asking the client to breathe
through one nostril while occluding the
other.
c)Select the nostril that has the greater
airflow.
11.Prepare the tube.
a)If a rubber tube is being used , place it on
ice for 5 to 10minutes. If a plastic tube is
being used , place in a warm water until the
tube is softer and flexible.
b.If a small-bore tube is being used, insert
stylet or guidewire into the tube making
sure that it is secured in position.
12.Determine how far to insert the tube.
a)Use the tube to mark off the distance
from the tip of the client’s nose to tip of the
earlobe and then from the tip of the
earlobe to the tip of the xiphoid process.
b)Mark this length with adhesive tape if the
tube does not have markings.
13.Insert the tube.
a)Put on gloves.
b)Lubricate the tip of the tube well with
water soluble lubricant or water to ease
insertion.
c) Insert the tube, with its natural curve
toward the client, into the selected
nostril.Ask the client to hyperextend the
neck and gently advance the tube toward
the nasopharynx.
d)Direct the tube along the floor of the
nostril and toward the ear on that side.
e)Slight pressure is sometimes required to
pass the tube into the nasopharynx and
some clients may water at this point.
Provide the client with tissues as needed.
d)If the tube meets resistance, withdraw it,
relubricate it and insert in the other nostril.
e)Once the tube reaches the
oropharynx(throat), the client will feel the
tube in the throat and may gag and retch.
Ask the client to tilt the head forward, and
encourage the client to drink and swallow.
f)If the client gags, stop passing the tube
momentarily. Have the client rest, take a
few breaths, and take sips of water to calm
the gag reflex.
g)In cooperation with the client, pass the
tube 5 to 10cm (2 to 4 in.) with each
swallow, until the indicated length is
inserted.
h)If the client continues to gag and the tube
does not advance with each swallow,
withdraw it slightly and inspect the throat
through the mouth.
14.Ascertain correct placement of the tube.
a)Aspirate stomach contents and check the
pH which should be acidic.
b)Auscultate air insufflation by placing a
stethoscope over the client’s epigastrium
and injecting 10 to 30ml of air into the tube
while listening for a whooshing sound.
c)If the signs do not indicate placement in
the stomach, advance the tube 5cm(2 in.)
and repeat the tests.
d)If a small-bore tube is used, leave the
stylet
15.Secure the tube by taping it to the
bridge of the client’s nose.
a)If the client has oily skin, wipe the nose
first with alcohol.
b)Cut 7.5cm (3in) of tape and split it
lengthwise at one end, leaving a
2.5cm(1inch)tab at the end.
c)Place the tape over the bridge of the
client’s nose and bring the split ends under
and around the tubing or under the tubing
and back up over the nose.
16.Attach the tube to a suction source or
feeding apparatus as ordered or clamp the
end of the tubing.
a)The tube,if inserted preoperatively, is
usually clamped or plugged: or it may be
covered with a gauze square or plastic
specimen bag and an elastic band.
17.Secure the tube to the client’s gown.
a)Loop an elastic band around the end of
the tubing and attach the elastic band to
the gown with a safety pin.
Or
Attach a piece of adhesive tape to the tube,
and pin the tape to the gown.
18.Document relevant information: the
insertion of the tube, the means by which
the correct placement was determined and
client responses.
19.Establish a plan for providing daily
nasogastric tube care.
a)Inspect the nostril for discharge and
irritation
b)Clean the nostril and tube with
moistened, cotton tip applicators.
c)Apply water soluble lubricant to the
nostril if it appears dry and encrusted.
d)Change the adhesive tape as required.
e)Give frequent mouth care. The client may
breathe through the mouth and cannot
drink.
20.If suction is applied, ensure that the
patency of both the nasogastric and suction
tubes is maintained.
a.)Irrigations of the tube with 30mL of
normal saline may be required at regular
intervals. In some agencies, irrigations must
be ordered by the physician.
b)Keep accurate records of the client’s fluid
intake and output, and record the amount
and characteristics of the drainage.
c)Document the type of tube inserted, date
and time of tube insertion, type of tube
used, color and amount of gastric contents
and the client’s tolerance of the procedure.
NGT Feeding
1.Assist the client to a Fowler’s position in
bed or a sitting position in a chair, the
normal position for eating. If a sitting
position is contraindicated, slightly elevated
right side-lying position is acceptable.
2.Explain to the client what you are going
to do, why it is necessary and how he or
she can cooperate. Inform the client that
the feeding should not cause any
discomfort but may cause a feeling of
fullness.For an adult, the usual intermittent
feeding will take about 30minutes;the
length of time depends largely on the
volume of the feeding.
3.Wash hands and observe appropriate
infection control procedures.(e.g.clean
gloves)
4.Provide privacy for this procedure if the
client desires it.
5.Assess tube placement.
a)Attach the syringe to the open end of the
tube and aspirate alimentary
secretions.Check the pH.
b)Allow 1 hour to elapse before testing the
pH if the client has received a medication.
c)Use pH meter rather than a pH paper if
the client is receiving a continuous feeding
or if food coloring has been added to the
formula.
6.Assess residual feeding contents.
a)Aspirate all stomach contents and
measure the amount before administering
the feeding.
b)If 100mL(or more than half the last
feeding) is withdrawn, check with the nurse
in charge or refer to agency policy before
proceeding.Thre precise amount is usually
determined by the physician’s order or by
agency policy.
c.Reinstill the gastric contents into the
stomach if this is the agency or physician’s
order. Remove the syringe bulb or plunger
and pour the gastric contents via the
syringe
d.If the client is on continuous feeding,
check the gastric residual every 4 to 6 hours
or according to agency protocol.
7.Administer the feeding.
a)Before administering the feeding: Check
the expiration date of the feeding.
Warm the feeding to room temperature.
b)When an open system is used, clean the
top of the feeding container with alcohol
before opening it.

Syringe(Open System)
8.Remove the plunger from the syringe to a
pinched or clamped nasogastric tube.

9.Add the feeding to the syringe barrel.

10.Permit the feeding to flow in slowly at
the prescribed rate.Raise or lower the
syringe to adjust the flow as needed. Pinch
or clamp the tubing to stop the flow for a
minute if the client experiences discomfort.
 DONA REMEDIOS TRINIDAD ROMUALDEZ MEDICAL FOUNDATION
COLLEGE OF NURSING

PERFORMANCE EVALUATION CHECKLIST

Procedure: NGT Termination

Name: _________________________________________ Year Level & Section: _____________

Date of Performance: _____________________________ Clinical Group: __________________

Procedure DON NOT DONE Remarks

E
1.Confirm the physician’s order to remove
the tube.
2.Assist the client to a sitting position if
health permits.
3.Place the disposable pad across the
client’s chest to collect any spillage of
mucous and gastric secretions from the
tube.
4.Provide tissues to the client to wipe the
nose and mouth after the removal.
5.Explain to the client what you are going
to do, why it is necessary and how he or
she can cooperate. Explain that the
procedure will cause the discomfort.
6.Wash hands and observe other
appropriate infection control procedures
(e.g. clean gloves)
6.Provide for client privacy.
7.Detach the tube.
a)Disconnect the nasogastric tube from the
suction apparatus, if present.
b)Unpin the tube from the client’s gown.
c)Remove the adhesive tape securing the
tube to the nose.
8.Remove the nasogastric tube.
a)Put on a disposable gloves.
b)(Optional) Instill 50mL air into the tube.
c)Ask the client to take a deep breath and
to hold it.
d)Pinch the tube with the gloved hand.
e)Quickly and smoothly, withdraw the tube.
f)Place the tube in the plastic bag.
g.)Observe the intactness of the tube.
9.Ensure client comfort.
a)Provide mouth care if desired.
b)Assist the client as required to blow the
nose.
10. Dispose of the equipment
appropriately.
a)Place the pad, bag with tube and gloves
in the receptacle designated by the agency.
11.Assess the nasogastric drainage if
suction was used.
a)Measure the amount of gastric drainage,
and record it on the client’s fluid output
record.
b)Inspect the drainage for appearance and
consistency.
12.Document all the relevant information.
a)Record the removal of the tube, the
amount and appearance of any drainage if
connected to suction, and any relevant
assessments of the client.